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Complications of diagnostic cardiac catheterization

Joseph P Carrozza, MD
Section Editor
Donald Cutlip, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Throughout the 1960s and 1970s, cardiac catheterization was primarily a diagnostic procedure that was used to evaluate hemodynamics, ventricular function, and coronary anatomy. However, the introduction of improved angioplasty equipment and new interventional devices in the 1980s made catheterization an important tool in the treatment of cardiovascular disease.

Although diagnostic catheterization and percutaneous coronary intervention (PCI) are done by skin puncture rather than incision, and under local rather than general anesthesia, they can cause a variety of adverse events, ranging from minor problems without long-term sequelae to major complications requiring immediate corrective action. Furthermore, newer interventional procedures may be associated with different and, in some cases, more frequent complications.

The most common complications associated with diagnostic cardiac catheterization will be reviewed here. The complications associated with cardiac catheterization involving PCI are discussed separately. (See "Periprocedural complications of percutaneous coronary intervention".)


The risk of producing a major complication (death, myocardial infarction, or major embolization) during diagnostic cardiac catheterization is generally well below 1 percent. As a result, the risk-to-benefit ratio still favors performing this procedure as a part of the evaluation of potentially fatal or lifestyle-limiting cardiac disease.

For the individual patient, the risk of an adverse event is dependent upon demographics, cardiovascular anatomy, clinical circumstances including comorbidities, the experience of the operator, and the type of procedure being performed (table 1A-C) [1]. Severe peripheral artery disease is a risk factor for all of the major complications.

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Literature review current through: Nov 2017. | This topic last updated: May 10, 2017.
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  1. Baim, DS, Grossman, W. Complications of cardiac catheterization. In: Cardiac Catheterization, Angiography and Intervention, Baim, DS, Grossman, W (Eds), Williams & Wilkins, Baltimore 1996. p.17.
  2. Johnson LW, Lozner EC, Johnson S, et al. Coronary arteriography 1984-1987: a report of the Registry of the Society for Cardiac Angiography and Interventions. I. Results and complications. Cathet Cardiovasc Diagn 1989; 17:5.
  3. Dorros G, Cowley MJ, Simpson J, et al. Percutaneous transluminal coronary angioplasty: report of complications from the National Heart, Lung, and Blood Institute PTCA Registry. Circulation 1983; 67:723.
  4. Kennedy JW. Complications associated with cardiac catheterization and angiography. Cathet Cardiovasc Diagn 1982; 8:5.
  5. Noto TJ Jr, Johnson LW, Krone R, et al. Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). Cathet Cardiovasc Diagn 1991; 24:75.
  6. Laskey W, Boyle J, Johnson LW. Multivariable model for prediction of risk of significant complication during diagnostic cardiac catheterization. The Registry Committee of the Society for Cardiac Angiography & Interventions. Cathet Cardiovasc Diagn 1993; 30:185.
  7. Wyman RM, Safian RD, Portway V, et al. Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol 1988; 12:1400.
  8. King KM, Ghali WA, Faris PD, et al. Sex differences in outcomes after cardiac catheterization: effect modification by treatment strategy and time. JAMA 2004; 291:1220.
  9. Hemmelgarn BR, Southern DA, Humphries KH, et al. Refined characterization of the association between kidney function and mortality in patients undergoing cardiac catheterization. Eur Heart J 2006; 27:1191.
  10. Gruberg L, Mintz GS, Mehran R, et al. The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol 2000; 36:1542.
  11. Pracyk JB, Wall TC, Longabaugh JP, et al. A randomized trial of vascular hemostasis techniques to reduce femoral vascular complications after coronary intervention. Am J Cardiol 1998; 81:970.
  12. Ward SR, Casale P, Raymond R, et al. Efficacy and safety of a hemostatic puncture closure device with early ambulation after coronary angiography. Angio-Seal Investigators. Am J Cardiol 1998; 81:569.
  13. Kapadia SR, Raymond R, Knopf W, et al. The 6Fr Angio-Seal arterial closure device: results from a multimember prospective registry. Am J Cardiol 2001; 87:789.
  14. Silber S, Gershony G, Schön B, et al. A novel vascular sealing device for closure of percutaneous arterial access sites. Am J Cardiol 1999; 83:1248.
  15. Silber S, Tofte AJ, Kjellevand TO, et al. Final report of the European multi-center registry using the Duett vascular sealing device. Herz 1999; 24:620.
  16. Baim DS, Knopf WD, Hinohara T, et al. Suture-mediated closure of the femoral access site after cardiac catheterization: results of the suture to ambulate aNd discharge (STAND I and STAND II) trials. Am J Cardiol 2000; 85:864.
  17. Koreny M, Riedmüller E, Nikfardjam M, et al. Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA 2004; 291:350.
  18. Nikolsky E, Mehran R, Halkin A, et al. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol 2004; 44:1200.
  19. Geary K, Landers JT, Fiore W, Riggs P. Management of infected femoral closure devices. Cardiovasc Surg 2002; 10:161.
  20. Cherr GS, Travis JA, Ligush J Jr, et al. Infection is an unusual but serious complication of a femoral artery catheterization site closure device. Ann Vasc Surg 2001; 15:567.
  21. El-Jack SS, Ruygrok PN, Webster MW, et al. Effectiveness of manual pressure hemostasis following transfemoral coronary angiography in patients on therapeutic warfarin anticoagulation. Am J Cardiol 2006; 97:485.
  22. Krueger K, Zaehringer M, Strohe D, et al. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 2005; 236:1104.
  23. Katzenschlager R, Ugurluoglu A, Ahmadi A, et al. Incidence of pseudoaneurysm after diagnostic and therapeutic angiography. Radiology 1995; 195:463.
  24. Webber GW, Jang J, Gustavson S, Olin JW. Contemporary management of postcatheterization pseudoaneurysms. Circulation 2007; 115:2666.
  25. Muller DW, Shamir KJ, Ellis SG, Topol EJ. Peripheral vascular complications after conventional and complex percutaneous coronary interventional procedures. Am J Cardiol 1992; 69:63.
  26. Popma JJ, Satler LF, Pichard AD, et al. Vascular complications after balloon and new device angioplasty. Circulation 1993; 88:1569.
  27. Paulson EK, Sheafor DH, Kliewer MA, et al. Treatment of iatrogenic femoral arterial pseudoaneurysms: comparison of US-guided thrombin injection with compression repair. Radiology 2000; 215:403.
  28. La Perna L, Olin JW, Goines D, et al. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation 2000; 102:2391.
  29. Hamraoui K, Ernst SM, van Dessel PF, et al. Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection. J Am Coll Cardiol 2002; 39:1297.
  30. Greenwood MJ, Della-Siega AJ, Fretz EB, et al. Vascular communications of the hand in patients being considered for transradial coronary angiography: is the Allen's test accurate? J Am Coll Cardiol 2005; 46:2013.
  31. Barbeau GR, Arsenault F, Dugas L, et al. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients. Am Heart J 2004; 147:489.
  32. Benit E, Vranckx P, Jaspers L, et al. Frequency of a positive modified Allen's test in 1,000 consecutive patients undergoing cardiac catheterization. Cathet Cardiovasc Diagn 1996; 38:352.
  33. Hovagim AR, Katz RI, Poppers PJ. Pulse oximetry for evaluation of radial and ulnar arterial blood flow. J Cardiothorac Anesth 1989; 3:27.
  34. Kotowycz MA, Dzavík V. Radial artery patency after transradial catheterization. Circ Cardiovasc Interv 2012; 5:127.
  35. Pancholy S, Coppola J, Patel T, Roke-Thomas M. Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv 2008; 72:335.
  36. Cubero JM, Lombardo J, Pedrosa C, et al. Radial compression guided by mean artery pressure versus standard compression with a pneumatic device (RACOMAP). Catheter Cardiovasc Interv 2009; 73:467.
  37. Harvey JR, Wyman RM, McKay RG, Baim DS. Use of balloon flotation pacing catheters for prophylactic temporary pacing during diagnostic and therapeutic catheterization procedures. Am J Cardiol 1988; 62:941.
  38. Tsang TS, Freeman WK, Barnes ME, et al. Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience. J Am Coll Cardiol 1998; 32:1345.
  39. Keeley EC, Grines CL. Scraping of aortic debris by coronary guiding catheters: a prospective evaluation of 1,000 cases. J Am Coll Cardiol 1998; 32:1861.
  40. Bashore TM, Gehrig T. Cholesterol emboli after invasive cardiac procedures. J Am Coll Cardiol 2003; 42:217.
  41. Fukumoto Y, Tsutsui H, Tsuchihashi M, et al. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol 2003; 42:211.
  42. Tommaso CL. Contrast-induced nephrotoxicity in patients undergoing cardiac catheterization. Cathet Cardiovasc Diagn 1994; 31:316.
  43. King SB, 3rd, Smith, SC Jr, Hirshfeld, JW Jr, et al. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation 2008; 117:261. Available at: www.circ.ahajournals.org (accessed January 29, 2008).
  44. Chambers CE, Eisenhauer MD, McNicol LB, et al. Infection control guidelines for the cardiac catheterization laboratory: society guidelines revisited. Catheter Cardiovasc Interv 2006; 67:78.